Tag Archives: Healthcare.gov

While there are plenty of valid reasons to be skeptical about the Affordable Care Act, regardless of where you fall on the political spectrum, it’s hard to argue that imposing an individual mandate to purchase insurance won’t result in more people obtaining coverage. According to the results of a recent survey conducted by the Centers for Disease Control and Prevention (CDC), that’s precisely what’s happened. Based on results of the National Health Interview Survey, researchers at the CDC estimate that nearly 4 million people gained insurance coverage from January to March of 2014. Of course, we also know that people tend to procrastinate, and that consequently, there was a surge of last-minute sign-ups occurring in March. Those newly insured individuals aren’t accounted for in the CDC’s findings, and other estimates that include those individuals put the number of newly insured at between 8 and 10 million. Even then, as Jonathan Gruber is quoted saying in the New York Times, “This is really a three-year process of implementation….Trying to draw strong conclusions from one quarter of one year is impossible.” The bottom line is: The early indications are that more people have coverage, and things seem to be moving in the right direction. But let’s not get ahead of ourselves.

According to another report, though, the end of the third quarter may bring a slight uptick to the number of uninsured. Apparently, Uncle Sam has actually been checking on the information people submitted through Healthcare.gov when they signed up for coverage. As it turns out, the Centers for Medicare and Medicaid Services (CMS) found that nearly 1 million people had issues documenting their status as U.S. citizens. Most of these people were citizens, complied with requests to submit proper documentation, and have kept their coverage. But there are still 115,000 people who have failed to submit documentation by the government’s September 5th deadline. As I’m writing this, these people have two weeks to get their documentation in order. If they do not do so by September 30th, they will lose their coverage. On top of this, more than 350,000 other people–who are unquestionably U.S. citizens–may lose their federal subsidies that lowered the cost of their insurance, because they didn’t submit verifiable proof of income to the government. Together, this represents nearly one-half million people that could be at risk of going without insurance once again after only part of a year.

The issue is whether the discrepancies in documentation are accurate reflections of reality. If someone is an undocumented immigrant, the law is clear that they are not entitled to purchase health insurance through the exchange. Likewise, if someone makes more money than they claim, the law is clear that they are only entitled to the amount of subsidy that corresponds to their actual income. So, if the failure to provide verifiable documentation is legitimate, then by denying these individuals coverage, or eliminating their subsidy, the government is simply correcting a mistake it should not have made to begin with. That is, these people should never have qualified for coverage or a subsidy. However, we know all too well the technical issues that Healthcare.gov has experienced, and many people are claiming that they have tried to upload their documentation electronically without success. If the fault lies with a federal website that continues to experience glitches, it isn’t appropriate to deny people who are lawful residents of the U.S. and/or who have accurately reported their income to be denied coverage. Which is the case? I can only speculate, but I’d be willing to bet it’s a mixture of both. What I do know is that this is one more wrinkle in a complicated implementation process. But, to paraphrase Dr. Gruber, we’ve got at least two more years to iron things out.

Like this:

Remember when everyone was talking about how awful healthcare.gov is? Well, guess what? At least 4 states are recommending that their citizens use the federal site because theirs are so bad. That’s a nice about-face huh? Here’s what the governor of one of those states, Oregon, says:

“I think their recommendation to use the federal website technology is the right call,” he said. “It is the most reliable and least costly way to ensure that we have a working website for the next enrollment period.”

Wait, what? Healthcare.gov is the “most reliable”? I love it. I really do. That is damning with faint praise if I ever heard it. So, fine. Those state’s residents can just go over to the federal site. No harm, no foul. Here’s the catch. The government, the federal one, gave a whole bunch of money to those states to start their own exchanges. Do we get our money back?

Now, whatever we may think about past and future hospital CEOs, sometimes they get it right. Dear leader Brad Wright might think this is cheating, but I’m going to re-post a blog entry by a CEO who’s probably doing more for health policy now than he was when he was a CEO. Here it is: (http://runningahospital.blogspot.com/2014/04/i-want-my-money-back.html)

“Like many people, I have been following the saga of the failed state health care exchanges, Massachusetts being one. But a sentence in today’s New York Times Article about the Oregon exchange took my breath away:

Oregon has received $305 million in federal grants to build its exchange, according to the Congressional Research Service.

The Census Bureau reports the number of households in Oregon as 1.5 million. So we (yes, we) have spent about $300 per family to produce nothing.

As we look at that CRS report we see that Massachusetts got $170 million for the same purpose and couldn’t get its act together. Hawaii, $205 million. Maryland, $171 million. And, in addition, according to the Pioneer Institute report, “Failure at the Connector will cost Massachusetts taxpayers over $100 million dollars this year” because 160,000 Massachusetts residents are on temporary public Medicaid coverage even though they don’t qualify for MassHealth.

On Oregon, the Times reports:

[I]n February, the federal government delivered a devastating critique of the Oregon exchange, saying it had “no integrated project schedule” and no “overarching dedicated project manager” to keep work on track. Moreover, it said, the state did far too little to supervise its main information technology contractor, Oracle.

I strongly support the goals and purposes of the Accountable Care Act, but this level of managerial incompetence is breathtaking. Shouldn’t we as federal taxpayers ask for the failed states to return the US grants they received? Perhaps, then, the states will have an incentive to recover the spent funds from the contractors they hired.”